Fall From a Car Resulting in a Right Upper Limb Axillary Artery Vascular Injury

A young male patient was brought to the Emergency Department after falling from a moving car. It was noted that he had a left scalp hematoma with a deformed right upper limb. Computer tomography of the head, cervical spine, thoracic and lumbar spine, thorax, abdomen, and pelvis was performed. The CT scan showed multiple cervical spine fractures, a fracture of the first rib with localized pneumothorax, and multiple lung contusions. There was also a fracture of the right humerus. CT angiography showed evidence of a complete cutoff of the right axillary artery at its origin in the axilla, which was compressed by a hematoma. He was immediately taken for emergency surgery by the trauma team and underwent right subclavian artery grafting by the vascular surgical team. The plastic surgery team performed a right forearm fasciotomy and right brachial plexus repair. The orthopedic team applied an external fixator to the right humerus. During his hospital stay, the patient developed severe sepsis presumed to be due to pneumonia, and was treated with piperacillin-tazobactam along with vancomycin. He was discharged after a hospital stay to a long-term facility for continued physiotherapy.